Blood pressure measurement in haemodialysis patients

Cerrai, T; Benedetti, Inés; Scala, F.; Gori, Mauro; Nicolini, S.; Pampaloni, S.; Paolini, Rossella; Piccioli, G.C.; Righi, Maria; Romoli, Roberto; Torricelli, Simona

doi:10.1111/j.1755-6686.1999.tb00020.x

Cited by 1 publication

(1 citation statement)

References 13 publications

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“…In studies in which the pre/postdialysis BP and ABP were reported separately for two groups (21)(22)(23)(24)(25), results were pooled by taking the square root of the weighted average of the variances. In two studies, the correlation coefficients between ABP and pre/ postdialysis BP but not the SD of the routine BP were reported (26,27). Data from these studies were used to calculate pooled correlation coefficients but not for calculating the weighted mean difference between BP.…”

Section: Resultsmentioning

confidence: 99%

Pre- and Postdialysis Blood Pressures Are Imprecise Estimates of Interdialytic Ambulatory Blood Pressure

Agarwal

Peixoto

Santos

et al. 2006

Clinical Journal of the American Society of Nephrology

213

154

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H ypertension is perhaps one of the most pervasive problems of patients with ESRD. Although current guidelines that focus on cardiovascular disease in dialysis patients call for hypertension control as a top priority, the vast majority of patients who are on hemodialysis are hypertensive and control rates are poor (1). For practical reasons, BP assessment and antihypertensive treatment in patients with ESRD is performed on the basis of measurements that are made either immediately before or after dialysis. Such timehonored practice is widely accepted and formally recommended by clinical guidelines. The recent National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines suggest that predialysis and postdialysis BP should be Ͻ140/90 and Ͻ130/80 mmHg, respectively (2).Population-based studies, including the recent Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) (3) and Ohasama studies (4) and studies on patients who had hypertension and were referred to a specialist clinic in the Dublin Outcome Study (5), have demonstrated clearly that ambulatory BP monitoring (ABPM) provides more accurate prognostic information than office BP, an issue that seems to be of particular relevance in the elderly. In a recent analysis of the ABPM substudy of the Systolic Hypertension in Europe (Syst-Eur) trial (6), ABPM and clinic BP did not identify the same patients for antihypertensive treatment, and ABPM was a better predictor of cardiovascular outcomes than clinic BP. These considerations are of relevance to patients with ESRD because uremia is a strong catalyst of the aging process and because patients with ESRD are older, with an average age of 60 yr.Given that the population with ESRD is elderly and the relationship between ABPM and cardiovascular outcomes and total mortality has scarcely been studied, we examined the magnitude of the difference between ABPM and pre/postdialysis BP. We hypothesized that if there were substantial differences, especially when differences between the two methods of measurements were unpredictable, then the two methods of measurement may have differing prognostic significance. The primary objective of this systematic analysis was to determine the magnitude of the difference and the variability in the difference between BP that is recorded in the dialysis environment, before and after the dialysis procedure, and ABPM that is performed simultaneously in the hemodialysis population. Materials and MethodsPublished studies that had reported paired ABP and pre/postdialysis BP in patients who were undergoing conventional three times a Published online ahead of print. Publication date available at www.cjasn.org.

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